ABSTRACT
Obstructive uropathy is defined as the structural or functional interruption of urinary outflow at any level in the urinary tract. It is regarded as one of the most prevalent causes of acute kidney injury (AKI), accounting for 5%-10% of cases. Acute severe obstruction of the urinary tract is a potentially threatening situation for the kidneys and therefore requires prompt identification and management to relieve obstruction. The aim of the present article is to review and synthesize available evidence on obstructive uropathy, providing a clinical guideline for clinicians. A literature review on obstructive uropathy in the context of AKI was performed, focusing on the least clarified aspects regarding diagnosis and management. Recent literature searching was conducted in English and top-level evidence articles including systematic reviews, metanalyses and large series were prioritized. Acute obstruction of the urinary tract is a diagnostic and therapeutical challenge that may lead to important clinical complications together with direct structural and hemodynamic damage to the kidney. Early recognition of the leading cause and its exact location is essential to ensure prompt urinary drainage together with the most suitable drainage technique selection. A multidisciplinary approach, including urologists, nephrologists, and other medical specialties, is best suited to correctly manage concomitant hemodynamic changes, fluid and electrolyte imbalances, and other related issues. Obstructive uropathy is one of the leading causes of AKI. Recognition of patients suitable for early diversion and feasibility or adequate selection of the indicated technique is sometimes challenging. A thorough understanding of the physiopathology behind the development of urinary obstruction is vital for correct diagnosis and management.
ABSTRACT
Background: The improvement of absent or partial response in the medical treatment of erectile dysfunction (ED) has led to the development of minimally invasive new treatment modalities in the field of regenerative medicine. Methods: A literature review on stem cell therapy for the treatment of ED was performed. We searched for the terms "erectile dysfunction" and "stem cell therapy" in PubMed and Clinicaltrials.gov. Literature searching was conducted in English and included articles from 2010 to 2022. Results: New treatment modalities for ED involving stem cell therapy are not only conceived with a curative intent but also aim to avoid unnecessary adverse effects. Several sources of stem cells have been described, each with unique characteristics and potential applications, and different delivery methods have been explored. A limited number of interventional studies over the past recent years have provided evidence of a safety profile in their use and promising results for the treatment of ED, although there are not enough studies to generate an appropriate protocol, dose or cell lineage, or to determine a mechanism of action. Conclusions: Stem cell therapy is a novel treatment for ED with potential future applications. However, most urological societies agree that further research is required to conclusively prove its potential benefit.
ABSTRACT
Introducción: Dado el aislamiento existente entre los farmacéuticos comunitarios y los miembros de los equipos de atención primaria en nuestro país, se diseñó este estudio para explorar las opiniones de profesionales de la salud de Osakidetza y de farmacia comunitaria, sobre la posibilidad de inte-gración de ambos colectivos. Método: Se diseñó un estudio cualitativo utilizan-do el Grupo Focal como método de obtención de información con análisis temático del contenido. La reunión tuvo lugar en el Centro de Salud de Gros (OSI Donostialdea). Participaron diferentes profesionales tanto de Osakidetza (n=6) como de la farmacia comunitaria (n=2). Todo el proceso de la reunión grupal y su informe, se realizó siguiendo los Standards for Reporting Qualitative Research (SRQR). Resultados: La Farmacia tiene como elementos fuertes su frecuentación, cercanía y facilidad de ac-ceso viéndose como un recurso no suficientemente aprovechado. A pesar de la dificultad conceptual de integrar un colectivo privado con otro público, se entendía la necesidad de acercamiento inter-profesional a través de una integración funcional, proceso que por su complejidad será lento y largo. Se debe comenzar con los programas locales ya existentes, proyectos pequeños, con objetivos concretos e indicadores medibles y mejorando la comunicación interprofesional y el conocimiento mutuo. Se analizaron las barreras a superar y los agentes implicados que deberían participar en cualquier proyecto futuro de integración siguiendo un modelo de diseño compartido.Conclusiones: Parece importante integrar funcio-nalmente la Farmacia comunitaria en Osakidetza SVS.(AU)
Introduction: Due to the lack of integration of com-munity pharmacy and primary health care teams a study was designed to explore the views of stake-holders in the Basque health care system (Osakide-tza) on the integration of community pharmacy and primary healthcare teams.Method: A qualitative study, using focus group technique was used. The group met in the Gros health care center (IHO Donostialdea). There were 6 participants from the Basque primary health care system and 2 from community pharmacy. The whole focus group process followed the Standards for Reporting Qualitative Research (SRQR) and data generated was thematic content analysis.Results: The group identified the inherent strengths of community pharmacy as accessibility, geograph-ical distribution and frequency of visits by patients. Pharmacy was seen as a resource that was not optimally used. Despite the philosophical dilemma posed by the integration of a private (community pharmacy) and public (salaried health care profes-sionals) sector, there was seen a need for interpro-fessional collaboration, via functional integration due to the complexities and length of time required. The starting point was identified as existing rela-tively small local programs with specific objectives and measurable outcomes that increase commu-nication and build mutual confidence. The content analysis indicated a number of barriers and iden-tified potential stakeholders that should codesign any future potential integration program.Conclusions: There was general support for the integration of community pharmacy in the primary care system however this was tempered with sig-nificant barriers which would suggest a lengthy and complex process.(AU)